Initial Planning Questionnaire

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1 Initial Planning Questionnaire Josh Koehnen CERTIFIED FINANCIAL PLANNER TM Registered representative of and offering securities and advisory services through Independent Financial Group, LLC (IFG) member FINRA and SIPC and an investment adviser representative of and offering advisory services through Financial Designs Limited (FDL) a CA state registered investment adviser. IFG is not affiliated with FDL. Office of Supervisory Jurisdiction: High Bluff Drive, Suite 100, San Diego, CA

2 General Information 2 Your Name Spouse s Name Social Security # Social Security # Citizenship Citizenship Date of Birth Age Date of Birth Age Wedding Anniversary Date Wedding Anniversary Date Employer/Position Years Employer/Position Years Home Address Mailing Address Work Address Work Address Home Phone Home Phone Work Phone Work Phone Cell Phone Cell Phone CPA Information Attorney Information Bank Information Broker/Agent Information Total Family Income $ Value of Liquid Assets $ Value of Primary Residence $ Total Family Net Worth $ # of Dependents Ages Mortgage Amount $ Notes/Concerns

3 Savings 3 What do you consider an adequate cash reserve? $ Investment Planning Is your investment portfolio providing an acceptable growth rate? Yes No Uncertain Is your investment portfolio providing acceptable income? Yes No Uncertain Are you expecting any major gains or losses soon? Yes No Uncertain Do you have a stock margin (loan) account? Yes No Uncertain Are there any investments you are planning on making in the near future? Yes No Uncertain If yes, what are they? Investment Planning Some investments lock up your principal for a specific period of time. For example, after purchasing a one-year certificate of deposit, your principal cannot be withdrawn without paying a penalty to get the principal back until the end of the one-year period. Regarding your investments, you want your principal to be: Life Insurance Mainly liquid asssets (i.e. convertible to cash within 7 14 days) Short lock-ups are acceptable (1 3 years) Longer lock-ups are acceptable (4 10 years) How much total life insurance do you have on yourself? $ How much total life insurance do you have on your spouse? $ Tax Planning Is your current tax liability acceptable? Yes No Uncertain Have you been, or do you expect to be, audited by the IRS? Yes No Uncertain Do you have Capital Loss Carry Forward? Yes No Uncertain If yes, how much? Estate Planning Do you have a current Will? Yes No Date Do you have a current Revocable Living Trust? Yes No Date Do you have a current Durable Power of Attorney? Yes No Date Do you have a current Health Care Power of Attorney? Yes No Date

4 Investment Objectives 4 1. Which of the following investments, if any, would you feel uncomfortable owning (select all that apply)? Corporate Bonds Stocks of U.S. Companies Stocks of International Companies Real Estate Limited Partnerships Alternative Investments 2. How much experience do you have with the following investments and savings vehicles: (List number of years experience for each category) Large U.S. Company Stocks Small U.S. Company Stocks International Stocks Emerging Markets Stocks International Bonds Limited Partnerships Alternative Investments Rental Real Estate Real Estate Investment Trusts (REIT s) Variable / Fixed Annuities Money Market Funds U.S. Savings Bonds (EE or H series) Certificates of Deposit U.S. Treasury Notes, Bills 3. Is your investment portfolio intended primarily for retirement? Yes No If yes, how many more years until you retire? If already retired, check here 4. If this portfolio is for other than retirement, what is the portfolio for? 5. Based on the above investment goal(s), which of the objectives below best describes your desired approach towards your investments? Emphasis on preserving principle rather than growing asset value. Emphasis on maintaining purchasing power while generating moderate to high current income. Emphasis on increasing portfolio value with small potential for loss. Emphasis on creating strong growth in asset value with moderate fluctuations in value. Emphasis on maximizing growth with high likelihood of large fluctuations in asset value. 6. Investment management styles are termed as being active or passive. Active management entails actively buying and selling stocks or funds attempting to select the best picks for the immediate future. Passive management entails an allocation of index type stocks or funds with the emphasis on maintaining a consistent diversified mix of various investment classes and allowing the market to generate the return. Which statement reflects your feeling on portfolio management style? I prefer an active management style. I prefer a passive management style. I would like a mix of active and passive management. I pay you to make this decision.

5 Investment Objectives 5 7. Historically, smaller companies tend to have higher levels of risk (price volatility) than large company stocks. However, small company stocks have tended to outperform large company stocks over long periods of time. Knowing that past performance never guarantees future results, which statement most accurately describes your attitude towards small company stock investing? I definitely do not want any small company stock exposure in my portfolio. I would dedicate a small portion of the portfolio to small company stock investments. I would dedicate a large portion of the portfolio to small company stock investments. 8. Similar to above, International (non-u.s.) stocks have tended to perform counter-cyclical to U.S. stocks through multi-year cycles, sometimes higher, sometimes lower. Given that foreign securities involve additional risks (such as currency valuation changes) and potential for additional returns, which statement most accurately reflects your view on international investing? I definitely do not want any international investment exposure in my portfolio. I would dedicate a small portion of the portfolio to international stock investments. I would dedicate a large portion of the portfolio to international stock investments. I would like significant exposure to international investments including emerging countries. 9. Five years from now, what do you expect your earnings to be? I expect my earnings increases will outpace inflation (due to promotions, new job, etc.).. I expect my earnings increases to stay somewhat ahead of inflation. I expect my earnings to keep pace with inflation. I expect my earnings to decrease (retirement, part time work, etc.). 10. What percentage of your portfolio s present value do you need to currently withdraw for annual income? (e.g. 4% of a $500,000 portfolio equals $20,000 per year) None 0% 2% 2% 4% 4% 6% More than 6% 11. Except for income as noted in Question 10, in approximately how many years do you expect to need to withdraw cash from your investments (home purchase, college tuition, other major need)? 2 3 years 4 6 years 7 10 years 10+ years 12. What do you do with the income (interest, dividends and capital gains) generated by your portfolio Receive all income Receive some income and reinvest some Reinvest all income 13. What is the approximate average annual return that you consider reasonable from your portfolio over the next 10 years 4% 6% 8% 10% or more

6 Risk Tolerance & Sensitivity Below is a series of hypothetical portfolios. The best potential gains, worst potential losses and average returns are presented. Note that the portfolio with the best potential gain and average return also had the largest potential loss. Which portfolio would you be most comfortable owning? A B C D E F -50% Worst One-Year Returns -50% -45% -35% -30% -20% -40% -30% -20% -15% -10% Long-Term Average Returns 5% 6% 8% 10% 11% 12% 15% 20% 30% 35% Best One-Year Returns 45% 55% 0% 10% 20% 30% 40% 50% 60% For illustrative purposes only 15. Which of the following would concern you the most regarding the return of your portfolio in a one year period? Have a negative return representing a loss in value. Have a return less than my income withdrawal goal. Under-perform the market index returns. Under-perform my investment goal. 16. Which of the following statements best describes your reaction if the value of your portfolio suddenly declined 15%? (e.g. $500,000 goes to $425,000) I would be very concerned. If the amount of income I received was unaffected, it would not bother me I invest for long-term growth and accept temporary changes due to market fluctuations 17. Approximately what portion of your monthly take home pay goes towards paying off installment debt (auto loans, credit cards etc.) other than home mortgage? Less than 10% 10% 25% 25% 50% More than 50% 18. How many dependents, other than your spouse, do you support (children, elderly parents, family members, etc.)? None More than Do you have an emergency cash fund (savings equal to 3 6 months of after tax income)? No Yes, but less than six months of after-tax income. Yes, I have an adequate emergency fund. 20. If you expect to have major expenses (college, house down payment, home repair, etc.) do you have a separate savings plan for these expenses? Yes I do. I do not expect any such expenses. I intend to withdraw only a portion of the money needed from savings. I have no separate savings plan for these items at this time.

7 Investment Objectives If you could increase the value of your portfolio by taking more risk, would you be: Willing to take a lot more risk with all of your money. Willing to take a lot more risk with some of the money. Willing to take a little more risk with all of your money. Willing to take a little more risk with some of the money. Unlikely to take much more risk. 22. When you think of the word risk as it relates to your investments, how would you describe your feelings 23. How often do you want your portfolio performance to be evaluated for the purpose of possibly making changes in the investments? Quarterly Annually Every 3 years 3 years or more 24. Will you be making additions to your investment portfolio over the next five years? Yes No Additional Considerations Are there any unique factors or concerns that we should understand regarding the management of your investment portfolio or risk tolerance?

8 Privacy Statement 8 Your Privacy I s I mportant to Us We are committed to maintaining the confidentiality, integrity and security of your personal information. When you provide personal information, we believe that you should be aware of our policies to protect the confidentiality of that information. Information We Collect We collect nonpublic personal information about you from the following sources: Information we receive from you on planning documents, statements, applications or other forms such as tax returns and estate planning documents; Information about your transactions with us, our service providers, or others. Disclosure of Your Information We restrict access to nonpublic personal information about you to those employees with a legitimate business need for the information. We maintain physical, electronic, and procedural safeguards that comply with federal standards to guard your nonpublic personal information. We reserve the right to disclose all of the information that we collect, as described above, to any affiliates that we may have at that time and to the following types of nonaffiliated third parties: Our Broker-Dealer, Independent Financial Group, LLC; Financial service providers, such as securities broker-dealers, third-party investment advisors, investment sponsors, custodians, mortgage bankers and insurance agents/brokers; Any new Broker-Dealer with whom we become registered. We do not sell, share or disclose your nonpublic personal information with non-affiliated third party or marketing companies for unrelated purposes. Client s Signature Date Spouse s Signature Date Advisor s Signature Date

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